A new peer-reviewed paper published in the Journal of Food Protection argued that routine restaurant inspection data are an underutilized resource for preventing foodborne illnesses, and that analyses connecting inspection data with outbreak surveillance data could potentially help prevent foodborne illness outbreaks.

The review, authored by researchers from the University of Minnesota and the University of Helsinki, examined the links between routine restaurant inspection findings and foodborne illness outbreaks or sporadic foodborne illnesses. The authors asserted that data from foodservice establishment inspections and public health surveillance are not typically integrated in a way that allows regulators to assess the risk of illness transmission directly associated with patterns of food safety noncompliance.

The Impact of FDA’s Food Code and Jurisdictional Inspection Policies 

According to the paper, approximately 60 percent of reported foodborne illness outbreaks in the U.S. occur in restaurants, and the results of investigations into these outbreaks provide context for the scientific basis of the U.S. Food and Drug Administration’s (FDA’s) Food Code. The authors cited evidence showing the success of Food Code-based interventions in achieving positive public health outcomes. For example, routine inspections to evaluate compliance with the Food Code have helped reduce outbreaks linked to toxin-producing pathogens like Clostridium perfringens and Staphylococcus aureus by targeting key risk factors such as temperature abuse and poor personal hygiene.

Beyond efforts to improve compliance with FDA’s Food Code, the authors also highlighted evidence that inspection grading and public disclosures may reduce sporadic foodborne illness rates. For example, after New York City implemented letter-grade posting requirements for restaurants in 2010, inspection scores improved and Salmonella infection rates declined by 5.3 percent per year, compared to the rest of New York State, which did not see a similar trend. Other research has shown that having a grading method for restaurant inspections and public disclosure of scores is associated with fewer re-inspections, foodborne illness complaints, foodborne illness outbreaks, and Salmonella infections—suggesting that aggregating measures of foodborne illness can be useful for evaluating the impact of inspection policies.

Understanding the Relationship Between Inspection Findings and Foodborne Illnesses

The review highlighted several approaches to understanding the relationship between routine inspection results and foodborne illness outbreaks:

• Examining differences in compliance history between outbreak-associated foodservice establishments and non-outbreak-associated establishments
• Comparing the results of restaurant inspections between individual establishments among a group of restaurants that received the same implicated food item in a single outbreak
• Considering the aggregate outbreak rate for restaurants that have higher hygiene scores compared to those with lower hygiene scores. 

Although the findings of studies based on these approaches have varied, overall, such analyses suggest that:

• Comparing inspection histories from outbreak restaurants to non-outbreak restaurants can elucidate opportunities to control the transmission of specific pathogens through compliance with Food Code provisions
• Studies comparing restaurants that received the same potentially contaminated product within one outbreak may be useful for distinguishing the level of risk posed by the product itself from the risk associated with how the product was handled, which can be especially useful for outbreaks involving fresh produce
• Analyzing aggregate outbreak rates for establishments with high or low hygiene ratings offers an opportunity to understand the impact of jurisdiction-level improvements in compliance on outbreak rates.

Barriers to and Benefits of Linking Inspection and Illness Data

The paper identified several barriers to linking inspection and illness data in the U.S., including:

• Fragmented oversight across more than 3,000 state, local, tribal, and territorial (SLTT) agencies
• Inconsistent adoption of FDA Food Code versions, hindering direct comparisons across jurisdictions
• The use of paper inspection forms by some jurisdictions and the lack of standardized, analyzable databases.

If these challenges could be overcome, the researchers believe that the standardized collection and analysis of inspection data could improve outbreak investigations, identify pathogen-specific transmission pathways, support environmental assessments, and help regulators target prevention efforts more effectively.

The authors concluded that linking restaurant inspection data with foodborne illness surveillance could provide a novel framework for reducing foodborne illness transmission in foodservice establishments and strengthening public health prevention efforts.